Initial Behaviour Intake Form. This form is required in order to book a behaviour consult for your dog(s). Please answer with as much detail as possible. Every form is reviewed carefully by our staff to ensure we are able to provide you with the best assistance possible.

Name *

Name

First Name

Last Name

Email Address *

Street Address *

Phone Number *

Phone Number

(###)

###

####

How did you hear about Wildflower Dog Training?

What is the main issue you wish to work on? *

How serious is your dog's issue? *

Not at all serious (1)

Slightly serious (2)

Moderately serious (3)

Very serious (4)

Extremely serious (5)

Tell Us About Your Canine Friend

Your Dog's Name *

Sex *

Male, Intact

Male, Neutered

Female, Unspayed

Female, Spayed

Breed and Age

How long have you had your dog?

Have you done any training with your dog? And if so, with whom?

How much exercise does your dog get on an average day?

Aggression and Bite History

Has your dog ever snapped at or bitten another dog or person? *

Please check all that apply

My dog has snapped at another dog

My dog has bitten another dog

My dog has snapped at a person

My dog has bitten a person

No. Not applicable.

If your dog has bitten, please explain what happened

Severity of the worst bite

Did not break skin

Broke skin but did not puncture deeply

Punctured to the depth of a canine tooth

Multiple bites

Bit and shook, leaving gashes and tears in the skin

Not Applicable

Medical

Does your dog suffer from any known medical conditions? If so, please specify.

Please list any known allergies (food or otherwise)

Please list any current medications your dog is taking

Your Vet *

Disclaimer of Liability

I hereby agree to indemnify and hold harmless Wildflower Dog Training, its owners, trainers, employees, representatives and landlords from any and all liability for any loss, damage or injury to any person, any animal or anything, that may have arisen out of, or is in any way connected with, participation in training and behavioural consultations on or off Wildflower Dog Training properties. Furthermore, I assume all responsibility for any loss, damage or injury to myself, my guests, my dog or my property, which may have been caused by negligence, or any action or inaction, of any person connected in any way with the above said services.